Summary

Family Physicians, the subjects of this trial are reluctant to initiate insulin in patients
with type 2 diabetes due to a lack of familiarity and comfort with this clinical strategy.
This study will test the effectiveness of diabetes specialist consultation support, and
community pharmacy insulin initiation support on the insulin prescribing behaviour of family
physicians across Canada.

Study Design

basal insulin initiation strategy
Support by Specialist and Pharmacist

This multifaceted intervention consists of (1) Diabetes Specialist Consultation Support which entails specialists and educators providing consultation for insulin initiation and titration for the 12 months following the Workshop. Support will consist of prearranged and scheduled communications to review and advise for the first 2 months and will continue on an ad hoc basis for the remaining 10 months, with communication initiated by the physician (2)Community Pharmacy Insulin Initiation consists of trained community pharmacists providing patient education insulin initiation. Education will consist of one individual teaching session, one hour in duration, to review the insulin prescription protocol, insulin injection method, management of hypoglycemia, and self-monitoring of blood glucose.

Eligibility Criteria

Male or female participants of any age.

Inclusion Criteria:
- Full time physicians >25 hours per week in office
- Ability to generate a listing of patients with type 2 diabetes (T2DM) from their
practice or billing records.
- Generation of a practice list of patients with T2DM
- A minimum of 50 patients with type 2 diabetes in their practice.
- Support the generation of a Diabetes Practice Profile prior to the deadline
established
- A minimum of 6 insulin-eligible patients
- Attendance at the scheduled Workshop (if unable to attend the Workshop must be
available to be educated and trained by DNE using a Workshop DVD)
Exclusion Criteria:
- FP does not attend Workshop or complete educational training using Workshop DVD with
DNE guidance
- FPs who anticipate retiring within the post-intervention period, moving their
practice to another city, or having locum coverage of their practice for more than 4
weeks during the post-intervention period
- FPs currently participating in a diabetes behaviour-change intervention trial
- FPs working in an academic environment
- FPs unlikely to comply with protocol, (uncooperative attitude, unlikelihood of
completing the study).

Additional Information

Official title

Advancing INSIGHT Methods in General Practice

Principal investigator

Stewart B. Harris, MD MPH FCFP

Description

The 2003 Canadian Diabetes Association clinical practice guidelines recommend early and
sustained glycemic control targeting an A1C < 7%. The guideline target however is not
achieved in 50% of patients with type 2 diabetes in the Canadian family practice setting.
Family physicians are not comfortable initiating and managing insulin for their patients the
DICE study5 found that only 12% of the 2473 patients audited were prescribed insulin; 6%
insulin alone and 6% in combination. Harris et. al. found 20% of patients prescribed
insulin, 15% insulin alone and 5% in combination. A strategy to increase physicians'
knowledge, skill and comfort with insulin prescription is needed to better achieve glycemic
control for patients with type 2 diabetes in Canada.
Purpose - The purpose of AIM@GP is to increase family physicians clinical experience and
comfort with insulin prescription and better achieve glycemic control for patients with type
2 diabetes in Canada.
Primary Objective - To determine the effectiveness of a Basal Insulin Initiation strategy on
family physician insulin prescribing behaviour. The strategy, using a multifaceted
behaviour facilitation approach, includes diabetes specialist consultation support, and
community pharmacy insulin initiation support.
Study Design - The study design is a stratified, parallel group, randomized control
effectiveness study. All physicians will attend an insulin education workshop where they
will receive a Diabetes Practice Profile and randomly allocated in a 1:1 manner into the
intervention or control group.